Stress and Decision Making When Dealing With Infertility

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We now have so much information about infertility, from what healthy sperm looks like to understanding how to begin to identify problems like PCOS. The internet makes this information readily accessible. On the other hand, it is difficult to find information about the emotional journey of infertility. I am not talking about stress and infertility and the ongoing fears many patients have about feeling too stressed to conceive. That is an issue that has been addressed widely, and sadly, too many people continue to blame themselves for their infertility. That is a subject for another day.

Today I will provide a couple of examples of how the stress of family-building efforts can be more insidious than you may have imagined. Everyone knows that going through infertility is stressful but perhaps we don’t consider that it may be so stressful that it can lead you to make unhelpful decisions.

Let’s start with egg freezing, a fertility treatment that is growing in popularity. I have consulted with hundreds of egg-freezing patients and published research in this area. One of the problems I have discovered is that when people undergo egg freezing, they often become intensely focused on deciding how many cycles of eggs to freeze. This makes sense because people want the best chance of having a child in the future. However, the stress of this choice, and sometimes the cost, can lead people to emotional conversations with their doctor about how many eggs they will need in the future. The conclusion is based primarily on age, but what often gets missed, as people hyper-focus on the number of eggs they can retrieve, is their future goals.

One question that rarely gets asked is, if fertility treatment is not successful using their own eggs, would they be willing to use someone else’s genetics to have a child, namely through adoption or donor conception? Why is this important? Because the people who are willing to consider non-genetic parenthood as a possibility have an alternative, even if it is not their first choice. Therefore, those people may not need to freeze as many eggs as the people for whom, having a non-genetic child is not an option.

Surrogacy

Surrogacy contracts remind me of reading the back of a Tylenol label: There are too many potential problems to consider, especially when it comes to medical testing and termination issues. If we worried about each possible problem on the back of the label, we would never take the Tylenol. Similarly, surrogacy contracts are full of frightening scenarios that often paralyze the decision process. Patients react by talking to their surrogates about broad ethical and medical issues, and if they feel they have a similar sensibility with each other, they think they will agree on every possible problem that could arise.

Thera are two difficulties with this assumption. The first is that there are truly too many possible scenarios to list on a contract. Second, medical problems are rarely black and white. Rather, the doctor often tells the couple that their embryo or fetus may have some percentage chance of developing a certain condition. To some people ten percent is too much and to others, ten percent inconsequential. Therefore, it is not possible to agree on all possible iterations of all possible conditions.

Understandably, when problems surface, patients want second and third opinions. Then the pregnancy progresses, and it becomes even more difficult to make a decision. If instead, they could step back from the overwhelm and use a different framework, they may be able to become clearer as a group and, if something goes wrong they can be in a place where they are better able to manage this situation than they would otherwise.

One framework I like to use is to think about is grouping all medical testing and termination issues in two buckets. One bucket would hold all issues relating to the gestational carrier’s health and the other bucket would hold all issues relating to the fetus or baby. This way, if something goes wrong, the gestational carrier can focus on her health and the intended parents can make the difficult decision about whether or not they can parent a child with that difficulty.

The Takeaway

When we consider creating a family we are often more stressed than we know, and our minds often hyperfocus on minimizing discomfort by finding what looks like the clearest answer. If instead we can calm our nervous systems enough to refocus, instead of our brains trying to escape discomfort, we may be better able to look at our choices from all angles and find solutions that more accurately reflect our long-term goals.